Community Medicicne

Dr.Nasih Lec:-3-
4-Oct-06

Etiology of Disease
The epidemiologic approach

Is mycobacterium tuberculosis enough to cause TB?

Why all of us don’t get influenza during an epidemic?

Disease is not simply caused by a single factor…..

Epidemiologists consider etiology of disease in the wider context of the
biological, physical and social environments.

The epidemiologic triad

 Disease results from interaction of three factors:

 The host (person)

 The agent
 The environment

 For some diseases another factor, the vector, can be added.

The epidemiologic triad

Agent

v
ect

Host Environment
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Example
Measles:
 Host: susceptible person
 Agent: measles virus
 Environment: conditions for exposure of susceptible persons

Burns:
 Host: susceptible person
 Agent: physical/chemical
 Environment: conditions for exposure/injury

1- Host factors

Responsible for the degree of susceptibility or resistance to the effects of the agent.
Influenced by:

 Genotype

 Nutritional status

 Immune system

 Social behavior

Example of host factors

 Age: childhood vaccine preventable diseases

 Sex: coronary heart disease/ pregnancy related problems

 Race: CA stomach

 Religion: Osteomalacia

 Behavior/Habits: diarrhea
 Occupation: pneumoconiosis

 Genetics: hemophilia

 Marital status: sexually transmitted diseases

 Other/Previous diseases: malnutrition/AIDS

 Immune status: immune/ immunosuppression

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2- Agent factors

 Biologic: allergens/ infectious agents

 Chemical: toxins (lead, organophosporous)/ dusts

 Physical: kinetic( bullets/ accidents), heat, cold, radiation, noise

 Nutritional: lack/ excess

 Social and psychogenic factors

3- Environmental factors
Conditions that facilitate contact between the host and the agent

 Temperature: (colds/ cholera)

 Humidity: (fungal)

 Altitude: (malaria)

 Crowding: (colds)

 Housing: (TB)

 Water: (giardiasis)
 Food: (goiter/ gastroenteritis)

 Radiation: (cancers)

 Air pollution: (asthma)

 Noise: (impairment of hearing)

 Socioeconomic: (anemia, TB, coronary heart disease)

 Political ??

4- Vector factors

A living carrier such as an insect that transports an infectious agent from a host
to another.
 A vector can be considered part of the environment or treated
separately

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  The vector has a specific relation to the host, the agent and the
environment

Examples of vectors

 Insects: anopheles mosquitoà malaria

 Arthropods: tickà relapsing fever

 Animals: dog à rabies

Some people prefer to use the term vector more widely to include:

 Human beings: vendors of heroin and cocaine à drug addiction

 Contaminated needles à HIV/AIDS

 Airplanes: cholera

But classically vector is applied to a living transmitter of disease that is essential

to the disease cycle.

Risk factors of disease

The BEINGS Model

An easy way to classify and remember the risk factor of disease is BEINGS
model

 B: Biologic/ Behavioral
 E: Environmental
 I: Immunological
 N: Nutritional
 G: Genetic
 S: Services

1) B: Biologic/ Behavioral factors

 Risk of disease may be influenced by age, gender, weight, presence of

other diseases/ pathologies, strain of pathogen

 Behavioral: certain behaviors may make individuals more or less

susceptible for certain individuals: smoking, handwashing, drug
addiction, use of seatbelt

2) E: environmental factors

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  Physical environment: temperature, humidity, sanitation, ventilation

 Social environment: socioeconomic status, overcrowding, education

3) I: Immunologic factors

 Presence or absence of immunity: previous exposure to disease(measles),

vaccination

 Immunosuppression: drugs, diseases (AIDS)

4) N: Nutritional factors

 Quantity and quality of nutrition

 Lack of macro and micro-nutrients: malnutrition and anemia weaken

resistance to diseases

 Excess: obesity

 Refined diet, high fiber diet

“Populations with large stools have small hospitals, those with small stools have
large hospitals” (Denis Burkitt)

5) G: Genetic factors

 Genetics now account for a higher proportion of diseases because of fall in

incidence of non-inherited diseases. Polio is now rare so juvenile
musculoskeletal disorders shows an increased heritability of childhood
paralysis

6) Services, social and spiritual factors

 Health care services ( availability/ access/ use)

 Traditional beliefs (health related beliefs)

 Social patterns ( gatherings, interfamilial marriages)

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Written By:
Rand Aras Najeeb